End of Life Treatment Preferences of Latino Medicare Beneficiaries with Cancer Principal Investigator: Isabel Torres, Dr.P.H. The overall goal of the NCI K01 career development plan is to provide the candidate with a program of mentored research activity and study in the areas of palliative cancer care, health disparities and outcomes research to launch an independent research career with specialization in the integration of these research areas. The five-year plan is carefully designed to 1) obtain further research experience in the areas of palliative cancer care, health disparities and health services research; 2) advance skills related to the design and analyses of prospective palliative care studies through training in advanced statistical methods; 3) improve skills needed to develop and test new instruments and performance measures to improve the accuracy of assessing quality outcomes for both English and Spanish speaking Latinos with cancer; 4) acquire further grant writing skills and experiences, resulting in the submission of an R01 grant before the end of the support period. Properly identifying the end-of-life preferences of cancer patients is a national healthcare priority and understanding the clinical, cultural, psychosocial and system-level factors that influence these decisions is paramount for clinicians and policymakers trying to respect patient preferences and improve their quality of care. The aim of the study is to determine if declining health status influences the end-of-life treatment preferences in Latino Medicare beneficiaries with cancer and how these preferences are modified by factors such as acculturation, health literacy, medical mistrust, provider ethnicity or the use of interpreters, or patient navigators. Participants will be 100 older Latino Medicare beneficiaries with breast, colorectal or prostate cancer, stage III or greater, and 100 contemporaries without cancer. Persons without cancer will be surveyed only once cross-sectionally and those with cancer will be interviewed at baseline and then monthly until twelve months or death to capture the preferences of both those who are undergoing rapid decline and those who are stable. Understanding the relationship between declining functional status and the treatment preferences of older Latinos with cancer has important clinical and policy implications, as findings could influence the use of written documents for advance care planning and inform the content and frequency of discussions that may be needed to capture changes in preferences triggered by changes in health status. We expect the proposed area of study and research that integrates palliative cancer care and health disparities research and applies prospective analytic methods to investigate a critical and understudied area to make a significant contribution to cancer care research. PUBLIC HEALTH RELEVANCE: End-of-Life Treatment Preferences of Latino Medicare Beneficiaries with Cancer Latinos are the fastest growing segment of the older population and new Latino cancer cases are predicted to double within the next twenty years. A person with cancer's choices to forgo life-extending treatment may change over time and as their health declines, yet identifying their choices related to one of life's most difficult periods is not always easy. This study will determine if the combination of declining health, cultural factors and meeting the cultural and language needs of Latino cancer patients, influence their end-of-life treatment choices.